Provider Demographics
NPI:1801203534
Name:DUROSEAU, JEAN RICK
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:RICK
Last Name:DUROSEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-6138
Mailing Address - Country:US
Mailing Address - Phone:954-756-5923
Mailing Address - Fax:
Practice Address - Street 1:3510 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3329
Practice Address - Country:US
Practice Address - Phone:806-472-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127354363LP0808X
NM66489363LP0808X, 363LF0000X
TXARNP9302212363LF0000X
FL9302212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily